Web-Based Intervention for Postpartum Depression: Formative Research and Design of the MomMoodBooster Program

Abstract

Background: Postpartum depression is a significant public health problem affecting approximately 13% of women. There is strong evidence supporting Cognitive Behavioral Therapy (CBT) for successful psychosocial treatment. This treatment model combines cognitive and behavioral strategies to address pessimism, attributions for failure, low self-esteem, low engagement in pleasant activities, social withdrawal, anxiety, and low social support. Encouraging results have been reported for using Web-based CBT interventions for mental health domains, including the treatment of panic disorder, post-traumatic stress disorder, and complicated grief and depression. To date, however, Web-based interventions have not been used and evaluated specifically for the treatment of postpartum depression.

Objective: We describe the formative work that contributed to the development of our Web-based intervention for helping to ameliorate symptoms of postpartum depression, and the design and key components of the program.

Methods: A total of 17 focus group participants and 22 usability testers, who shared key characteristics with the participants of our planned feasibility study, took part. The proposed structure and ingredients of the program and mock-ups of selected webpages were presented to focus group participants. At various points, participants were asked a series of thought questions designed to elicit opinions and set the occasion for group discussion. At the end of the session, participants were asked to describe their overall reaction to the proposed features of the program emphasizing candid opinions about what they did not like and features they thought were missing and should be added. Usability testers were asked to interact with a series of seven different Web-based interactions planned for the program while receiving minimal direction. Each tester was asked to describe her thoughts using a think-aloud technique. They were then asked to consider all that they had learned about the program and complete the System Usability Scale that we adapted slightly to be appropriate for evaluating the proposed website. Transcripts from the focus groups and usability tests were reviewed by research team members for overarching themes with particular emphasis on suggested changes. A list emerged, and iterative and incremental adjustments were made as a result.

Results: The qualitative and quantitative data gathered in the focus groups and usability sessions reported here suggest that the new mothers involved had largely positive reactions to the major features of the program and that those program features performed well in terms of usability.

Conclusions: An overview of the eventual design, architecture, and key program ingredients of the MomMoodBooster program is provided including innovative features supplementing 6 core CBT sessions, which include a partner's website, a library, and individual feedback by a personal coach.

Keywords: Web-based intervention; formative research; postpartum depression.

Figure 1

Mock-up of Atlas.ti network view diagram of focus group participant comments showing theme of Engagement.

Figure 2

Overall adjusted System Usability Scale scores (N= 21) (patterned fill= Iowa usability testers; solid fill= Melbourne usability testers).

Figure 3

Dashboard for Personal Coach Webpage in MomMoodBooster Administrative Website (checkmarks indicate that participant has used certain interactions or viewed specific webpages).

Figure 4

Structure of MomMoodBooster program.

Figure 5

Webpage from MomMoodBooster Session 3 (Displays content participant has entered for personal list of Catastrophisizing Thoughts).

Figure 6

MomMoodBooster Tracking Tools used daily to track Mood Ratings and number of personally-selected Pleasant Activities accomplished.